Although free from characterized manic and depressive episodes, the euthymic period in bipolar disorder (BD) remains characterized by a whole host of difficulties, particularly relational. These difficulties are factors of vulnerabilities and relapses. People's perception of their own relationships has an impact on their symptomatology, their responses to treatment and on relapse rates. Young's early maladaptive schemas (EMS) approach proves to be relevant for understanding the construction of these perceptions and working on them. Nevertheless, to this date, few studies have investigated which EMS are related to relationship dysfunction in this particular population. Determining the link between EMS and relationship difficulties would be relevant to understand psychosocial impairment of people with BD in euthymic states. The present study aims to investigate the associations between the different domains of EMS and relationship dysfunction among patients with bipolar disorder in the euthymic phase.

Data are extracted from the FACE-BD cohort, within the BD Expert Center in Versailles. Inclusion criteria were to be aged between 18 and 65 and to be an outpatient with a diagnosis of bipolar disorder (DSM-IV-TR). Patients had to be euthymic at the time of inclusion, according to DSM-IV-TR criteria with a cut-off score of 14 on the Montgomery-Asberg Depression Rating Scale and the Young Mania Rating Scale. Non-inclusion criteria were meeting at the time of the study the criteria for characteristic depressive episode, hypomania or mania according to the DSM-IV-TR. Sociodemographic data, clinical features associated with relationship dysfunction were assessed. EMS and EMS domains were assessed with the YSQ-R short form (Young Schema Questionnaire 3 Short Form) and current relationship dysfunction were assessed with the FAST (Functioning assessment short test subscale). Successive simple linear regression analyses were performed to investigate the association between the severity scores of each EMS and the intensity of relationship dysfunction. Furthermore, successive simple linear regression analyses investigated the association between EMS domain scores and intensity of relationship dysfunction. Multiple linear regression analyses were performed to test the association between EMS scores, then EMS domains, and the intensity of relationship dysfunction after adjusting for age as well as the intensity of residual depressive and manic symptoms.

Relationship dysfunction is partly associated with EMS activation in particular in the separation and rejection domain (P<0.0001), the other-directedness domain (P=0.031) and the over-vigilance and inhibition domain (P=0.005). Having residual depressive symptoms is also among the factors contributing to the relationship dysfunctions of people with bipolar disorder in the euthymic phase.

This is the first study demonstrating that the activation of several domains of EMS is a risk factor of relationships difficulties for people in euthymic phase of bipolar disorder. It is necessary to identify which EMS are specifically activated and their domains of belonging in order to prevent and reduce them. EMS are a lever for functional remission. It is therefore relevant to refer people reporting relationship problems to schema therapy consistent with a personalized care. Finally, future studies should focus on the mechanisms underlying the complex relationship between EMS domains and relationship dysfunction in people with bipolar disorder in the euthymic phase. It may also be relevant for future research to control for different types of relationship dysfunction. EMS may be differentially associated with several types of interpersonal problems. The relations between different adaptation styles and EMS should be further investigated to offer more personalized care, with the aim to improve functional remission.

Cette étude vise à explorer les associations entre les domaines de schémas précoces inadaptés (SPI) et le dysfonctionnement relationnel chez des personnes ayant un trouble bipolaire en phase d’euthymie.

Les critères d’inclusion étaient d’être âgé entre 18 et 65 ans, d’avoir reçu un diagnostic de trouble bipolaire (DSM), et d’être en phase d’euthymie au moment de l’étude. Les domaines des schémas précoces inadaptés étaient évalués au moyen du YSQ-3 version courte (Young Schema Questionnaire 3 Short Form) et le dysfonctionnement relationnel actuel au moyen de la FAST (sous-échelle du Functioning Assessment Short Test).

Avoir des symptômes dépressifs résiduels est un facteur associé au dysfonctionnement relationnel des personnes ayant un trouble bipolaire en phase d’euthymie. Avoir des schémas précoces inadaptés activés en particulier dans le domaine de séparation et rejet (p<0,0001), le domaine d’orientation vers les autres (p=0,031) et le domaine de survigilance et d’inhibition (p=0,005) augmente le risque d’avoir un dysfonctionnement relationnel important.

Cette étude est la première à montrer que le fait d’avoir plusieurs domaines de Schéma Précoces Inadaptés activés est un facteur de compréhension des difficultés que les personnes ayant un trouble bipolaire en phase d’euthymie ont dans les relations interpersonnelles. En ce sens les schémas précoces sont un levier pour la rémission fonctionnelle. Il s’avère donc pertinent d’orienter les personnes reportant des problèmes relationnels vers une thérapie des schémas.